Confused

[Tarabara]

---

Members don't see this ad.

I'm a nurse so please excuse my lack of knowledge regarding residency. I'm confused because I work on an acute medicine floor but we get interns and residents who are psychologists, podiatry, and even peds docs. I thought you guys went through the different rotations during medical school but by the time you got to residency you had your path set and therefore spent all your time in that specialty, but that doesnt seem to be the case. So can someone please explain to me (in a nut shell) why other specialties rotate through on our acute medicine teams? Thanks 🙂

 

[gutonc]

I can't explain the peds residents to you on an adult medicine service (unless they're med-peds double boarding or possibly peds neurology who have to have some adult gen med training), but I have also had both psychology and podiatry residents rotate on my medicine services in the past. They are generally pretty useless and are there to learn the "medical side" of the things they treat. So we usually punted all the malingerers and dual diagnosis folks (where I went to med school these were bipolar alcoholics with pancreatitis) to the psychology intern and all the chronic diabetic disasters to the podiatry intern.

 

[Flopotomist]

...maybe instead of asking us, you could ask one of them? Seems a bit odd to have psychologists and peds (although I would understand psychiatrists and med-peds).

 

[Tarabara]

Thanks for the replies, I guess I was more wondering why residents are still doing rotations? At one point do you stay in one area? Fellowship?

 

[Chakrabs]

Well residents need to be well-rounded too. The general practitioners out there that did an internal medicine residency need to be able to recognize and diagnose a whole host of diseases and properly refer patients that need advanced care to the right specialists. Thats why you see internal medicine residents rotating through various services. Even in more specialized residencies like orthopedics, the residents will spend time on a variety of subspecialities - spine, hip and knee, fracture, sports etc. It allows them the proper exposure needed to handle nearly any orthopedic patient as the vast majority of them will take some form of orthopedic call. And at the very least, the residents need to be exposed to the full scope of the field so they can see which subspecialty (if any) they may want to pursue.

 

[Winged Scapula]

In reference to Ortho residents, they may also do non-surgical rotations on Rheumatology and Neurology as well as surgical specialties ( like trauma, peds ortho, spine, hand, etc.).

Some internships have a wide variety of rotations built in - for example, Transitional Year residencies may have surgical, medical, Ob, peds, EM etc rotations during that year.

My surgical residency did not have any non-surgical/CC rotations but some do (i.e, EM or Gyn).

Each program designs their rotations based on the requirements of the relevant Board and needs of the residents. We used to have pharmacy residents on the SICU teams but never a psych or podiatry (but the Ortho teams sometimes had the latter).

 

[3dtp]

There are many reasons valid educational reasons why specialty residents would rotate off service. Medicine is a very broad and very deep field with lots of subtleties within it. I am a specialist, but when a patient walks into my office with atypical chest pain, I need to ask why?

For example I treat lung cancer patients, daily. They often get chemotherapy as well. When a patient walks in and just plain looks sick, It might be anemia due to general medical illness, it might be the chemotherapy, or they might be internally bleeding. In one case like this, I had a patient in new onset (no prior history) Afib/Aflutter with symptomatic tachycardia, acutely hypotensive, and my time spent in torment on the acute medicine services prepared me to recognize this immediately, get the patient properly admitted to the proper service and stabilized quickly. Another case, a patient was placed on a corticosteroid to reduce edema in a brain tumor, and showed up in clinic severely dehydrated, despite drinking copiously. A few questions and a lab test showed that the steroid had pushed his blood sugars into the 600+ range and there was every indication he had previously undiagnosed diabetes well prior to his present diagnosis. Again the torment I went through on medicine service rotations prepared me for this event.

Likewise, when I have medicine residents rotate through my service, they learn what radiation mucositis is, why it happens and what we can do about it. They also learn that a head and neck cancer patient with Stage IVA disease is a very different situation than a lung cancer patient with Stage IV disease. They also learn that a patient with an esophageal cancer with a bleed can be stabilized with transfusions while a very quick course of radiation will shrink the cancer causing the bleed, in many cases, within a week, ending the need for transfusions and the patient will have a better quality of life. These are all reasons why we cross train, and why some specialties have to spend a rotating internship year.

So, be patient with those new to your floor, they mean well, they do have good intentions, they may not know that they do not know anything, but by the time they leave, they usually have a very good idea of what they need to do, and they training they received in med school will prepare them to understand what is going on in much more detail and depth, and much ore rapidly, and they will become much better doctors. And they will thank you (hopefully) for your patience and understanding, as you help them learn more of what they may need to know a long time from now in an office far, far away.

I think you've asked a very good question, and I know that sometimes off service residents (and the new interns) may seem quite ignorant of your floor protocols. I know I was. Medical school gives a brief taste of what residents/interns really learn when they are newly minted, and residency gives a much deeper and more specialized drink of their chosen specialty.

This is why we have internship/residency and why the training is so much longer, intense and in some cases, harsh. A physician must know not only his own specialty, but also enough of the others to know when to punt the patient to the next specialist, and how to advise that specialist from his own perspective.

 

[Dermpath]

...maybe instead of asking us, you could ask one of them? Seems a bit odd to have psychologists and peds (although I would understand psychiatrists and med-peds).

Not really, there are medical psychologists and social workers, who specifically work with hospital-based patients and so it makes sense for them to rotate through medical services.

 

[Tarabara]

There are many reasons valid educational reasons why specialty residents would rotate off service. Medicine is a very broad and very deep field with lots of subtleties within it. I am a specialist, but when a patient walks into my office with atypical chest pain, I need to ask why?

For example I treat lung cancer patients, daily. They often get chemotherapy as well. When a patient walks in and just plain looks sick, It might be anemia due to general medical illness, it might be the chemotherapy, or they might be internally bleeding. In one case like this, I had a patient in new onset (no prior history) Afib/Aflutter with symptomatic tachycardia, acutely hypotensive, and my time spent in torment on the acute medicine services prepared me to recognize this immediately, get the patient properly admitted to the proper service and stabilized quickly. Another case, a patient was placed on a corticosteroid to reduce edema in a brain tumor, and showed up in clinic severely dehydrated, despite drinking copiously. A few questions and a lab test showed that the steroid had pushed his blood sugars into the 600+ range and there was every indication he had previously undiagnosed diabetes well prior to his present diagnosis. Again the torment I went through on medicine service rotations prepared me for this event.

Likewise, when I have medicine residents rotate through my service, they learn what radiation mucositis is, why it happens and what we can do about it. They also learn that a head and neck cancer patient with Stage IVA disease is a very different situation than a lung cancer patient with Stage IV disease. They also learn that a patient with an esophageal cancer with a bleed can be stabilized with transfusions while a very quick course of radiation will shrink the cancer causing the bleed, in many cases, within a week, ending the need for transfusions and the patient will have a better quality of life. These are all reasons why we cross train, and why some specialties have to spend a rotating internship year.

So, be patient with those new to your floor, they mean well, they do have good intentions, they may not know that they do not know anything, but by the time they leave, they usually have a very good idea of what they need to do, and they training they received in med school will prepare them to understand what is going on in much more detail and depth, and much ore rapidly, and they will become much better doctors. And they will thank you (hopefully) for your patience and understanding, as you help them learn more of what they may need to know a long time from now in an office far, far away.

I think you've asked a very good question, and I know that sometimes off service residents (and the new interns) may seem quite ignorant of your floor protocols. I know I was. Medical school gives a brief taste of what residents/interns really learn when they are newly minted, and residency gives a much deeper and more specialized drink of their chosen specialty.

This is why we have internship/residency and why the training is so much longer, intense and in some cases, harsh. A physician must know not only his own specialty, but also enough of the others to know when to punt the patient to the next specialist, and how to advise that specialist from his own perspective.

Thank you for the in-depth response, that makes a lot of sense. Yeah, many of our docs are quite ignorant of our protocols because I work for a VA hospital so we do things differently. I often hear "well thats not how we do it at the university hospital!" It can be frustrating at times to have some residents from different specialties because sometimes they give the impression that they dont care and are just trying to do their time and move on. But I am glad that you guys do get experience in other areas for the examples you just said above. Thanks again 🙂

 

[Law2Doc]

Thank you for the in-depth response, that makes a lot of sense. Yeah, many of our docs are quite ignorant of our protocols because I work for a VA hospital so we do things differently. I often hear "well thats not how we do it at the university hospital!" It can be frustrating at times to have some residents from different specialties because sometimes they give the impression that they dont care and are just trying to do their time and move on. But I am glad that you guys do get experience in other areas for the examples you just said above. Thanks again 🙂

First, those of us who have rotated to VA settings are more frustrated by the VA way of doing things than vice versa, I promise you. second, in residency unless you are in a transitional year (in which case you haven't necessarily chosen a specialty), you will be primarily working in a single specialty during residency. However you will also do a small handful of electives in other disciplines that are tangentially related to your main specialty, to get a bit of insight into your counterparts and hone some skills, as well as pass on some of your own. For example, a surgery resident might rotate through the ER because they see a lot of potential surgical patients, and do a fair amount of lines and bedside procedures. Family medicine rotates in surgery because when they are working out in the boonies, they may be the closest to a surgeon there is for miles. ER residents may do a few weeks of radiology because they are going into a very image driven specialty. And so on.